PROFESSIONAL SUMMARY

• 6+ years of experience in as business analyst, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare/insurance and Service Industry Sectors.
• Entrepreneurial self-starter capable of functioning with equal efficiency as an individual contributor or a team leader/player
• Experienced in managing various aspects of the software development lifecycle (SDLC) including requirements gathering, design, development, testing, deployment and support
• Wide-ranging experience in managing artifacts in methodologies such as Waterfall, RUP, Agile (SCRUM)
• Facilitated and participated in Joint Application Development (JAD) and Joint Resource Planning (JRP) sessions with management, SMEs, vendors, users and other stakeholders.
• Experience working with the business users as well as the senior management for web-based, and client server applications.
• Experience in FACET as an enrollment system.
• Experience in implementing Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
• Sound understanding of Gap Analysis using Swim lane diagrams, requirement management, risk analysis and project plans
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10.
• Experience with data mappings including ANSI 4010A1 835, 837I, P, 276/277, 278, 270, 997, 850, 834 for institutional, professional, and commercial.
• Strong skills in Software estimation - effort, time and budget
• Expertise in object oriented analysis and design (OOAD), unified modeling language (UML), use cases, UI development, usage models, layout and wireframes, test cases and user training
• Strong communicator and problem-solver skilled at analyzing/eliciting business needs and transforming them into technical designs, applying technical skills and business knowledge to achieve sound results.
• Excellent interpersonal dexterity with proven ability to converse, liaise, negotiate and relate with a wide range of personalities from diverse socio-economic and cultural backgrounds.

Operating Systems:

Microsoft Windows 95/98/NT/2000, XP, Vista, Mac OSX 10.3, MS-DOS, Linux.

Programming Languages

C++, ASP.NET 3.0/3.5, WPF, HTML/DHTML, VB.Net

Modeling/Requirement Mgmt. Tools

: MS Visio, CaliberRM, Rally, Rational RequisitePro, Rational Rose Data Modeler, Erwin.

Testing Tools:

Quality center, QTP, Load Runner, Win Runner, Test Director

Defect Tracking/Change Management Tools:

Rational Clear Quest, Rally, Bugzilla, MS TFS

Databases:

MS Access, SQL Server 2000/2005/2008, MYSQL, Oracle10g/9i/8i.

Confidential, Rochester, NY July 2010 - till
Business Analyst

The project is based on the implementing CHAMPS application which involves automated processing of the claims starting from filling the claims to paid the claims, also involved in the assessment and conversation from 4010 to 5010 standard and also closely working with B2B Team to let them understand project overview and importance of conversion.
Responsibilities:

• Facilitated JAD sessions with SMEs', Product owner, and Development managers to understand the business process, gather Business Requirements and identify enhancements for the application.
• Followed AGILE methodology viz. Scrum throughout the project.
• Prepared release plan and iteration plan for the project working with the stakeholders
• Re-factor Epics to Stories and maintain the prioritized Sprint backlogs
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Worked on FACET to terminate or reinstate health coverage for the subscriber.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to followICD 10Code set andANSI X12 5010formats.
• Documented requirement for HIPAA, EDI transaction 837 and for Medicare Part A, Part B, Part C and Part D.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validation.
• Researched/Analyzed the various steps involved in claims processing life cycle and then wrote the BRD in such way that developers could construct the system to identify riskier claims.
• Conducted requirement sessions, identifying business needs, getting sign-off on requirements and capturing requirements in CaliberRM and Rally.
• Facilitated pre-planning meetings, demos and daily stand ups.
• Wrote test cases and test scripts for the User Acceptance Testing (UAT).
• Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Assured that all Artifacts are in compliance with corporate SDLC Policies and guidelines.
• Worked with design team to prepare Project plan for User Interface documents.
• Tracked daily issues and dependencies and coordinated with common team to work on the impediment list.
• Conducted GAP analysis for fixed fee projects.
• Coordinated management of projects on MS SharePoint
• Used Rally and TFS for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Created traceability matrix to map requirements with test cases.
• Managed and assigned defects to the development team in Microsoft Team Foundation Server
• Created test plans for Test driven development (TDD)
• Prepared the application road map for upper management.

Environment:

Windows XP professional, MS Office suite, MS Project, UNIX/Oracle Platform, XML, Oracle Application server, Oracle Pl/SQL, MS Visio, Bugzilla,.MS Visio, Quality center, Clear quest, clear case.

Confidential, MN Nov- 2008 - June-2010
Business Analyst

The project was about implementing the HIPAA standards initiative of processing Professional and Institutional Claims using NDC over to HCPCS (Healthcare Common Procedure Coding System) which is the current processing standard and to assist with the Community Health Automated Medicaid processing system.

Responsibilities:

• Involved in requirements gathering sessions with SME's (Subject Matter Experts), Business Analysts and Architects to understand requirements in terms of business.
• Played a major role in collecting, documenting, blueprinting and managing business requirements.
• Actively worked on Business requirement analysis and Data analysis.
• Worked at different stages of Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.
• Worked on business process from taking a requirement from a systems record to a centralized database.
• Gathered requirements from the clients and developed crosswalks for 277/288, 834, 835, 837 P/I claims.
• Developed test cases based on the crosswalks and compliance guidelines for 277/288, 834, 835, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
• Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D. Conducted Gap Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
• Ensured that ICD-9-CM procedure codes used for inpatient services and CPT codes for outpatient and physician services were not outdated
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
• Participated in Forward Mapping and Backward Mapping analysis of ICD 9 - ICD 10.
• Participated in the JAD sessions along with the technical team members and clients to elicit requirements for HIPPA 4010 to 5010 migration process.
• Actively worked with quality control teams to develop test plans and test cases.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• Established Inner Join, Outer Join and created Indexes whenever necessary.
• Writing Standard SQL queries and optimizing SQL Queries
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Developed test scenarios and implemented test plans for system test and user acceptance test (UAT).

Environment: MS Office 2003, MS Project, UML, Rational RequisitePro 2002.05, MS Visio 2003, Rational Rose Data Modeler 7.0, Rational ClearQuest, SQL Server 2005, MS Visual Studio 2005, ASP.NET 3.0, MS Share Point 3.0, EDI, XML, WinRunner.

Confidential, Farmington hills MI June-2007-October-2008
Business Analyst
As a Business Analyst in Olympia Medicals, I performed pivotal role in multiple projects & handling three releases at the same time. Release 1 & 2 was web-based service application developed for streamlining office workflow processes involved in Electronic Data Interchange (EDI) transactions and benefits in claims management cycle based on HIPAA Guidelines. Release three was based on reporting the policy premium. There were seven reports, which were generated in Brio portal.
Responsibilities:

• Managed and leveraged valuable consulting experience in defining important Project Management & QA requirements that involved development using SOA (Service Oriented Architecture)
• Identified and mitigated risks on a weekly basis
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Wrote Test Cases and performed User Acceptance Testing (UAT), documented the in detail defects using the Defect Tracking report.
• Prepared and delivered Contingency Plan(s) as required.
• Define functional test cases, documented, and executed test scripts in FACET system
• Tracked project schedule and plans with Senior Manager(s), Directors and Officers
• Infrastructure planning for the project, including developing a SharePoint portal
• Advised on best practices in the IT industry for the development of the Requirements definition
• Managed and advised sub-contractors in following industry best practices
• Incorporated Rational Unified Process (RUP) to create BRD Specifications using MS Visio and MS Word.
• Used MS Visio for Process modeling and Business Process flow diagrams.
• Exposure to Human-Computer Interaction (HCI), User Interface (UI) Design and Usability Testing.
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
• Interviewed subject matter experts to identify and analyze Business Processes, end user behavior and expectations, and potential risks involved.
• Partnered with the internal users to gather, refine and evolve business requirements.
• Translated Business requirements into User Requirements Specifications.
• Created Traceability Matrix to keep track of user needs, features of the applications and use cases. Communicated with the business stake holders on a functional level and with the QA on a more technical level.
• Scanned and Reported bugs and re-tested fixed features. Wrote test cases for specific features in the system. Verified test cases documented by the QA team pertaining to other features in the system.
• Facilitated training and user adoption of the new application.

Environment: Windows XP professional, MS Office suite, MS Project, UNIX/Oracle Platform, XML, Oracle Application server, Oracle Pl/SQL, MS Visio.

Confidential, Hyderabad, India Nov-2006-April-2007
Business Analyst
Satyam is a IT Company based in India which performed Health care based project for Healthcare industry. A web application was reengineered to make it compliant with the EDI standards. Integration of this web applicationwith the third party administrator's applications (TPA) was achieved. The developed application is complaint with the HIPAA standards.
Responsibilities:

• Identified the project's stakeholders during initial meetings for the purposes of understanding the requirements.
• Prepared project plan and allocated resources working with Business analysis team and development team
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
• Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
• Conducted Functional Testing, Joint Functional Testing and UAT, documented and reported user feedbacks to management team.
• Assisted the PM on various projects throughout the Project Management Life Cycle (PMLC) including Project Charter, Project Plan and Resource allocation.
• Managed and updated daily project status using MS Project
• Mapped the entire process chain for which the system was being implemented, and created the Work Breakdown Structure to help facilitate in managing the projects better.
• Used RUP methodology and Unified Modeling Language (UML) to design, document, and manage requirements throughout lifecycle of the project.
• Transformed the business requirements maintained in the RequisitePro into Functional Requirements and prepared the Functional Requirement Document (FRD)
• Assisted development team in Preparing collaboration diagrams, sequence diagrams and UML notations for detailed analysis of business objects.
• Created test plan for QA and Usability testers
• Responsible for managing the documented system requirements and Requirements Traceability Matrix.

Environment: MS Office 2003, MS Project, XML, MS Visio 2000, Rational Clear Quest 2003, J2EE, Oracle, Win Runner, Load Runner, Windows NT